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Weight loss surgery: do the benefits really outweigh the risks?

Obesity prevalence is the highest it has ever been. The Centers for Disease Control and Prevention (CDC) states that more that one-third of American adults are affected. And with the increase in obesity comes an increase in the number of weight loss surgery procedures. But how safe are the procedures, and do the benefits outweigh the risks?

There is no doubt that obesity is a major cause of a number of serious and potentially life-threatening diseases.

What is bariatric surgery?

Bariatric surgery refers to a series of weight loss procedures that an obese individual can have in order to reduce their food intake, therefore causing them to lose weight.

A person is classed as obese if their body mass index (BMI) is over 30. If their BMI is over 40, they are deemed severely obese.

Obesity in the US has more than doubled since the 1960s, and this has prompted an increasing number of people to seek weight loss surgery.

There are three main bariatric surgery procedures that are widely used. These are gastric bypass, gastric banding and sleeve gastrectomy.

Gastric bypass is the most commonly used bariatric procedure worldwide, according to the ASMBS. The procedure involves re-routing the digestive system past the stomach in order to promote satiety and suppress hunger.

The gastric band procedure involves having an inflatable band placed around the top portion of the stomach. This creates a smaller stomach pouch, meaning eating less will make a person feel full and satisfy their hunger.

With a sleeve gastrectomy, around 80% of the stomach is removed to create a smaller stomach pouch. This reduces the amount of food that can be consumed.

Recovery time from these procedures varies from patient to patient. But it could take months for a patient to resume their normal daily activities following surgery, and many will have to follow a liquid diet and introduce normal foods slowly.

This prompts the question - why does bariatric surgery appear to be the preferred option over other weight loss interventions?

'Most effective option' for obese patients

According to Dr. Elliot Fegelman, medical director for Ethicon, a Johnson & Johnson company that designs and manufactures medical devices, standard diet and exercise strategies only lead to significant weight loss in 5% of the US population.

He adds:

"Surgery for weight loss and control of associated diseases, has been shown to be the most effective option available for patients suffering from obesity and related diseases."

For example, the ASMBS notes that a side effect of gastric banding may involve dilation of the esophagus (food pipe) if the patient overeats. This means patients need to stick to a strict diet for the rest of their lives and have regular postoperative follow-up visits.

Gastric bypass procedures also have their disadvantages. The ASMBS states that the surgery can lead to long-term vitamin and mineral deficiencies, and patients must have lifelong supplementation as a result.

Studies have also suggested that bariatric surgery may increase the risk of other health conditions.

Medical News Today recently reported on a study suggesting that women who have undergone weight loss surgery are more likely to give birth prematurely and have babies who are small in size for gestational age.

But Dr. Fegelman says that all surgeries present their risks, and these vary with each patient.

He adds:

"However, in the appropriate patients, the health risks from obesity far outweigh the risks associated with bariatric surgery.

Metabolic and bariatric surgery is associated with major reductions in risk of premature death over a 5-year period versus not having surgery, and in the US, the risk of bariatric surgery is now no greater than laparoscopic gall bladder surgery."

Patients 'need better advice to make decisions'

But Dr. Fegelman says he believes better communication is needed between doctors and obese patients, in order to ensure patients are better informed about the risks associated with bariatric surgery and whether the procedure is right for them.

"Bariatric and metabolic surgery is a major decision, and patients need time to consider it and explore their options. However, if a patient waits too long in their disease progression, the benefits from surgery may be impacted," says Dr. Fegelman.

In an attempt to help patients make their decision regarding bariatric surgery and help doctors inform patients about the benefits and risks, Ethicon have created a new online tool called The Ethicon Bariatric Surgery Comparison Tool.

The tool requires individuals to enter information such as their height, weight, ethnicity and age, and to select whether they have any weight-related health conditions, such as asthma, depression, liver disease or diabetes.

The online tool then searches over 75,000 bariatric surgery results of patients with similar health conditions.

Information is then presented to the user, detailing what their bariatric surgery options are, and the weight loss of similar patients over a period of 6, 12, 18 and 24 months after surgery.

Dr. Fegelman says the tool gives the user the opportunity to explore these results with their physician, enabling them to make better decisions.

"It's my hope that this tool will give doctors even more opportunity to explain the potential benefits and risks associated these procedures," he adds.

"The investment of surgeons in developing their skills, investment from hospitals in developing high quality teams, and investment from companies like Ethicon in the development of instruments and tools used every day in the operating room, contribute to the safety and efficacy of bariatric procedures."

Development of new bariatric procedures

There is no doubt that obese individuals are looking to bariatric surgery as a weight loss intervention now more than ever. And from this, researchers are looking for new surgical routes to aid weight loss.

A new study from researchers at Harvard Medical School has detailed one potential option - using a form of transarterial embolization.

The procedure is commonly used to treat a variety of medical conditions. It involves inserting an obstructive agent through a catheter and into an artery in order to stop blood flowing from the artery into a specific area of the body.

In this study, the investigators carried out embolization of the left gastric artery for gastrointestinal bleeding. It was found that patients who underwent this procedure experienced a 7.9% decrease in body weight 3 months following surgery.

The researchers say this procedure could be a potential bariatric treatment for weight loss and could be an alternative to other invasive procedures, such as gastric bypass.

"This is an important data point in the development of a new clinical tool for the treatment of obesity," says Dr. Rahmi Oklu, assistant professor of radiology at Harvard Medical School.

And with the rate of obesity in the US more than doubling since the 1960s, according to the US Department of Health and Human Sciences, it seems there is a desperate need for further weight loss interventions.

All treatment options should be discussed

Whether these interventions are in the form of bariatric surgery or more traditional non-surgery methods, one thing is clear - individuals who are obese need to talk to their doctors about their treatment options and be clear of the risks associated with them.

Dr. Fegelman says:

"We know that in the time-constrained environment of the doctor's office, talking about obesity can be a challenge.

Now that we have good information showing the improvements in health from, and the safety of [bariatric surgery], it is critical that doctors speak to their patients about the threat obesity represents and the options patients have to treat it."

Although there are many surgical options available to assist with weight loss, there is no denying the importance of following a healthy diet in order to maintain a healthy weight.

The US Department of Health and Human Services recommends that calories should be balanced with physical activity for healthy weight maintenance. Furthermore, they recommend increasing intake of fruit, vegetables and whole grains, and reducing intake of foods with high amounts of salt, saturated fats, trans fats, cholesterol, added sugars and refined grains.

Following a Mediterranean diet has also shown many benefits for weight and overall health. This diet mainly consists of high consumption of beans, nuts, cereals and seeds, consuming 25-35% of calorie intake from fat, and consuming cheese and yogurt as the main dairy foods.

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